Joshua Abrams, DO - Desert Institute for Spine CareJoshua Abrams, DO - Desert Institute for Spine Care

9 Treatment Options for Lower Back Pain

By Joshua Abrams, DO

Joshua Abrams is a fellowship-trained and board-certified orthopedic spine surgeon, specializing in minimally invasive surgery, artificial disc replacement, and cervical and lumbar spine surgery.

May 6, 2022

Lower back pain is a common complaint of many Americans. Acute back pain can last just a few days up to four weeks. Back pain that lasts longer than three months is considered chronic back pain. A lower back pain treatment can alleviate pain and discomfort, restoring mobility and a healthy range of motion.

Fortunately, numerous non-surgical and surgical treatments treat acute lower back pain and chronic back discomfort. Spinal physicians generally recommend non-surgical low back pain treatments before considering surgery. Learn how to treat lower back pain and what lower back pain treatment options are available.

Non-Surgical Treatments for Lower Back Pain

Approximately 16 million adults experience chronic or persistent back pain and are limited in daily activities. If you are looking for a chronic lower back pain treatment, you should ask your physician about non-surgical therapies to treat lower back pain. Physicians can improve back pain using non-surgical treatments without the need for more extensive surgery.

While spinal surgery is an effective treatment for back pain, spinal specialists prefer to see if a patient experiences improvement with non-surgical options. In many cases, a physician may suggest multiple non-surgical treatments for the best results. Some of the most effective non-surgical back pain treatments include:

Back Braces

A back brace is an effective back pain treatment, providing the spine with additional support. You can buy a back brace over the counter or receive a prescription from a physician. For the best results and improvement in symptoms, you should wear the back braces according to the physician’s suggestions or read the provided instructions.

Back braces can improve back pain because it provides additional stability and support to the back, which may be unstable because of weakened structures or injury. A back brace also helps minimize the pressure and strain placed on the spinal structures by taking the weight directly off sensitive spinal components.

A physician may also suggest a back brace following an accident or surgery, as a brace can minimize your range of motion, ensuring you don’t accidentally aggravate a healing portion of the spine. Finally, back braces reduce movement between the spinal segments, reducing tension and pain.

Physical Therapy

Physical therapy is an effective and safe treatment option for lower back pain, especially lumbar spinal stenosis. In most cases, a physician will recommend physical therapy for a minimum of four weeks to see if the patient experiences relief from pain or discomfort.

Physical therapy can help improve mobility, decrease pain and increase overall spinal functions.  A physical therapist can also educate patients on maintenance programs to continue at home to prevent future back pain. Physical therapy focuses on stretching and light exercises to improve spinal health and minimize pain, stiffness and discomfort.

Physical therapists also use passive treatments to alleviate pain in addition to active therapies. Passive physical therapy treatments include heat treatments, ice packs, ultrasound and transcutaneous electrical nerve stimulator (TENS), which send electrical pulses into the body to initiate the body’s natural pain killers.

A physical therapist may recommend iontophoresis as a back pain treatment. Iontophoresis is a method to deliver steroids through the skin. A specialist can apply steroids to the skin. Next, the specialist will use an electrical current on the skin to help migrate the steroid under the skin.

The steroids used in iontophoresis provide an anti-inflammatory effect within the area, minimizing pain and discomfort. Iontophoresis is very effective at relieving acute episodes of back pain.

Alternative Therapies

Alternative therapies, including spinal manipulation with a trained chiropractor, are another non-surgical treatment that can improve back pain. Spinal manipulation, also known as manual therapy or spinal manipulative therapy, involves moving the joints and massaging to alleviate pressure and reduce inflammation.

While specialists use spinal manipulation to treat back pain, they may also use it to alleviate shoulder, neck and headache pain associated with poor back health. One of the goals of spinal manipulation is to improve nerve function and reduce nerve compression.

Another alternative therapy for back pain is acupuncture. Acupuncture for back pain involves inserting thin needles at strategic body points and various depths. Research shows that acupuncture provides short-term benefits of functional improvement and pain relief for chronic lower back pain.

While acupuncture may sound intimidating if you have never tried the treatment before, the needles are exceptionally thin, meaning most people notice little to no discomfort during insertion. After insertion, a practitioner may gently manipulate the needles to promote pain relief.

Each acupuncture treatment is unique, and the practitioner will help decide how many needles are needed for pain relief. In most cases, needles remain in place for 10 to 20 minutes as you lie still. At the end of treatment, the specialist will gently remove the needles.

Medication

If certain non-surgical back treatments are not relieving your pain or discomfort, your physician may suggest medication. Muscle relaxers are one of the most commonly prescribed medications for back pain. Muscle relaxers can alleviate pain by decreasing spasms or tension in the back’s sore muscles.

In some cases, you will need to slowly discontinue muscle relaxers, especially if you use relaxants for an extended amount of time. When discontinuing muscle relaxers, it is essential to follow your physician’s instructions to avoid any negative symptoms. A doctor will slowly taper down your dose until you stop taking your medicine.

A physician may also recommend narcotics for short-term relief of severe back pain. While narcotics effectively minimize back pain, physicians don’t use these medications permanently to ensure patient health. Narcotics can minimize back discomfort because they attach themselves to your brain’s pain receptors, reducing the chemical signals creating a pain sensation.

Epidural Steroid Injections

Epidural steroids injections (ESIs) are an effective treatment for lower back pain and back pain that radiates down the legs. ESIs are considered essential aspects of non-surgical back pain management. ESIs inject a steroid medication and local anesthetic into the epidural space surrounding the nerve roots and spinal cord.

Spinal steroid injections can alleviate pain by minimizing swelling around the nerve roots. ESIs ensure patient comfort, allowing them to actively participate in physical therapy that otherwise may have been too painful. Finally, ESIs can enhance function and mobility in the lower back.

Steroid injections can help reduce or eliminate the need for oral medications. While oral medications are an effective pain relief tool, physicians advise against taking certain medications for the long term because they may have certain side effects.

ESIs can also help postpone or eliminate the need for extensive back surgery by providing non-surgical back pain relief. If ESIs and other non-surgical treatments effectively manage back pain, patients may not need to undergo back surgery. Although spinal surgery is an effective treatment, it is generally only recommended when patients do not experience pain relief from non-surgical treatments.

Surgical Treatments for Lower Back Pain

Spinal specialists may suggest surgical therapies if non-surgical back pain treatments don’t provide adequate relief. While spinal surgery is very safe and effective at treating back pain, it is a more intensive procedure, requiring extended downtime and recovery.

A spinal specialist may suggest spinal surgery for severe pain that doesn’t improve in six to 12 weeks of non-surgical treatments. Numerous types of back surgery are available for back pain relief, including:

Microdiscectomy

Microdiscectomy is a spinal surgery that surgeons often perform for a herniated spinal disc. During microdiscectomy, a surgeon can alleviate spinal nerve root pressure by removing the pressure-causing material that results in back pain.

Microdiscectomy involves removing a small portion of the bone over the nerve root and disc material located under the nerve root. In most cases, microdiscectomy is one of the most efficient and effective surgeries to remove the herniated portion of a spinal disc that causes nerve compression.

Although surgeons consider microdiscectomy an open surgery, many minimally invasive techniques can minimize the extent of the surgery. In many instances, a spinal surgeon can perform a microdiscectomy with a relatively small incision and minimal tissue disruption or damage.

Lumbar Laminectomy

Laminectomy is one of the most commonly performed types of spinal surgery. During a laminectomy, a spinal surgeon can remove a small portion of bone from the lower spine known as the lamina. A laminectomy is often performed in the lower spine — lumbar laminectomy.

Although a lumbar laminectomy is one of the most common spinal surgeries, a surgeon may perform a laminectomy on the middle of the back — thoracic laminectomy — and neck — cervical laminectomy. The lamina is a piece of bone often described as bony arches that protrude from the back of the spine.

A lumbar laminectomy releases the pressure and strain on compressed nerves, leading to pain reduction, enhanced mobility and improved quality of life. While a laminectomy is generally reserved for when non-surgical treatments are ineffective, a spinal surgeon may recommend a laminectomy if back pain and symptoms are severe or worsen very quickly.

If you experience numbness, weakness, inability to walk or difficulty standing, a surgeon will likely recommend a lumbar laminectomy. A lumbar laminectomy is often necessary if a patient is dealing with loss of bladder or bowel control.

Depending on the general health, the extent of surgery and the patient’s age, it can take approximately four to six weeks to two to three months to recover from a lumbar laminectomy.

Spinal Fusion

Spinal fusion is another spinal surgery designed to permanently fuse or connect two or more spinal bones known as vertebrae. The main goal of spinal fusion is to eliminate motion between two or more painful or damaged spinal bones by permanently connecting them.

Spinal surgeons use innovative surgical techniques designed to mimic the body’s natural healing of broken or damaged bones. When performing spinal fusion, a spinal surgeon will place bonelike material or natural bone into the space between two or more vertebrae.

A surgeon will also use screws, rods and metal plates to stabilize the vertebrae, holding them together to allow for proper healing. In addition to providing stability, fusion surgery can also correct spinal deformities, including scoliosis. While each patient is different, patients typically need a minimum of four weeks to three months to recover from spinal fusion surgery.

Artificial Disc Replacement

Finally, artificial disc replacement is used to treat chronic, severe back pain that causes degenerative disc disease. If six months of non-surgical spinal treatments don’t provide pain relief, artificial disc replacement is often recommended. Disc replacement surgery may also be recommended if back pain severely impacts mobility or limits a person’s ability to perform daily tasks. 

During artificial disc replacement surgery, a surgeon can replace the damaged or unhealthy spinal disc with a device that mimics the disc’s natural motion and movement. Artificial disc replacement aims to minimize pain by a painful degenerative disc while stabilizing and restoring the disc height. 

While lumbar fusion is an effective surgery, some patients may not experience relief from painful symptoms because fusion prevents normal spinal motion. Artificial disc replacement aims to preserve a normal range of spinal movement, making it an effective treatment for lower back pain.

In general, patients will need around three to four months to recover from artificial disc replacement. The spine will adjust to the artificial disc during the healing process and allow the surrounding structures and incisions to heal.

How Are the Causes of Lower Back Pain Diagnosed?

If you are experiencing acute or chronic back pain, your physician will likely suggest imaging tests to identify the source of your pain. Some of the most common tests that can help diagnose the cause of back pain include:

X-rays

X-rays are one of the most commonly used diagnostic imaging tools to assess and diagnose neck and back pain. An X-ray provides physicians with a detailed view of the spinal and is especially effective at detecting fractures and degenerative changes in the spine.

CT scans

Computed tomography (CT) scans create multiple X-rays at various angles to create a 3D image of the spine and surrounding soft tissues. CT scans are an effective diagnostic tool that can help physicians diagnose spinal stenosis, ruptured discs, spinal cord tumors, disc degeneration and spinal cord tumors.

Personalized pain mapping

Personalized pain mapping (PPM) is a precise, customized diagnostic approach to determine a patient’s spinal condition and pain source. While PPM isn’t a pain treatment, it can help you discover the cause of your pain, leading to more effective treatment.

MRI

A magnetic resonance imaging (MRI) and uses radio waves and magnetic fields to create clear images of the spinal bones and surrounding tissues, organs, bones and muscles. A physician may suggest an MRI if they think you may have a spinal tumor, disc rupture or infection.

Blood tests

In most cases, a blood test is not used to diagnose the cause of back pain. However, blood tests can be very helpful, allowing physicians to gain further insight into your overall health. A blood test may help a physician detect signs of inflammatory arthritis or infection.

These tests can help your physician diagnose an underlying medical condition causing spinal pain. Common medical conditions causing back pain include:

Spondylosis

Spondylosis is a term used to describe various types of age-related spinal degeneration. Between each spinal vertebra, there are three joints. The joint located at the front of the spine is known as the intervertebral disc. The facet joints are the remaining two joints at the back of the spine. With age, these structures begin to change and degenerate. Ligaments can thicken, cartilage degenerates and bone spurs can develop, causing pain and discomfort. Approximately one out of every 20 people experience spondylosis.

Herniated disc

A herniated disc is when the spinal disc (rubbery cushions in the spine) that sit between the vertebrae becomes injured or damaged. Spinal discs have a jellylike center known as the nucleus encased within a rubbery, tougher exterior. While a herniated disc can develop in any of the spinal discs, it is most common in the lower back. Research suggests every five to 20 per 1,000 adults develop a herniated disc each year with a male to female ratio of 2:1.

Facet joint syndrome

Facet joint syndrome causes pain that originates in the facet joints, typically of the lower back. In most cases, facet joint syndrome causes chronic or long-term back pain, which may be localized to the lower back or involve one or both legs if the spinal nerves become pinched or impinged near the facet joints. One study suggests the lumbar facet joints account for approximately 15% to 45% of lower back pain.

Sciatica

Sciatica causes pain along the sciatic nerve, traveling from the lower back to the buttocks and down both legs. While sciatica can affect both legs, it commonly occurs on just one side of the body. Sciatica occurs when the spine narrows, compressing the sciatic nerve. Research suggests a 10% to 40% lifetime incidence rate of sciatica.

Best Treatments for Lower Back Pain at DISC

The Desert Institute for Spine Care (DISC) is a premier provider of orthopedic and spine care. DISC surgeons are highly experienced and capable of diagnosing and treating various spinal conditions. Our goal is to provide customized, compassionate care to each person in a compassionate and understanding environment.

Contact us online to learn more about non-surgical and surgical treatments for back pain.

LEADERS IN MINIMALLY INVASIVE SPINE CARE
1635 E. Myrtle • Suite 400 • Phoenix, AZ 85020
Ph: 602-944-2900 • Fax: 602-944-0064

DISC - Desert Institute for Spine Care
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